Work Comp Audit Complaints: When Everything Else Fails

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What if you’ve done everything correctly and the claims administrator is just not paying your work comp medical bills? Your bills are authorized, complete, compliant, timely, and include all required documentation, but the claims administrator still doesn’t pay.

If you’re a provider of services to injured workers--doctor, copy service, DME, etc.--the California Department of Workers’ Compensation (DWC) gives you a way to report claims administrator’s bad behavior.

This mechanism is the Audit Complaint*.

Filing an Audit Complaint alerts the DWC that a particular claims administrator may need to be investigated; the more Audit Complaints filed against a claims administrator, the more seriously the DWC will take the complaints.

What’s more, you can file an Audit Complaint confidentially so there’s no risk of reprisal.

Of course, I encourage you to first try to work with the claims administrator to correct whatever is going wrong. But if a claims administrator demonstrates a pattern of poor compliance or just plain bad behavior, then please, for all of us, file an Audit Complaint.

Consider it a public service whenever you file an Audit Complaint, as it encourages a claims administrator to act in accordance with the rules, which benefits the entire workers’ compensation system.

If you’re a DaisyBiller, use the Audit Complaint feature within DaisyBill. It’s quick (literally 5 seconds!) and we make it super easy. How-to info here.

Whether or not you’re a DaisyBiller, we are happy to provide our expertise on how best to file Audit Complaints that will trigger action on the part of the DWC Audit Unit. Contact us and we’ll help.

Watch the FREE Audit Complaints Webinar:

*NOTE: The Audit Complaint form was updated in 2019. Access the updated form here: https://www.dir.ca.gov/dwc/Auditref.pdf

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DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.

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